双钢板固定结合奥邦植骨材料与自体髂骨植骨治疗复杂胫骨平台骨折的比较
|
摘要
背景:复杂胫骨平台骨折治疗方案的选择尚存争议。目的:比较双切口钢板内固定结合奥邦骨修复材料与自体髂骨植骨治疗复杂胫骨平台骨折的效果差异。方法:回顾性分析西南医科大学附属中医医院2015年1月至2017年1月收治,行双切口锁定钢板内固定结合植骨的71例复杂胫骨平台骨折患者的病历资料,根据植骨材料分为2组,观察组35例行双切口锁定钢板结合奥邦骨修复材料植骨,对照组36例行双切口锁定钢板结合自体髂骨植骨。所有患者对治疗方案均知情同意,治疗方案得到医院伦理委员会批准。对比2组手术时间、术中出血量、术后引流量及骨折愈合时间,详细记录2组术后膝关节损伤和骨关节炎评分、美国特种外科医院评分及Rasmussen影像学评分,随访期间对2组并发症情况进行统计。结果与结论:①2组患者经治疗伤口均愈合;②随访显示,观察组的手术时间、术中出血量、术后引流量、骨折愈合时间、膝关节损伤和骨关节炎评分疼痛项、症状项、Rasmussen影像学塌陷评分、总评分及并发症发生率均优于对照组,差异有显著性意义(P <0.05);③2组间的Rasmussen影像学成角畸形和髁部变宽评分、膝关节损伤和骨关节炎评分日常生活能力项、运动项及娱乐项比较差异无显著性意义(P> 0.05);④结果显示,与自体髂骨植骨相比,双钢板内固定结合奥邦骨修复材料植骨治疗复杂胫骨平台骨折能缩短手术时间、减少出血及并发症的发生,形成更强力的支撑,加速骨折愈合。
BACKGROUND: There are controversies about the treatment options for tibial plateau fractures.OBJECTIVE: To compare the clinical efficacy of double-incision locking plate combined with Osteobone implantation and autologous iliac bone graft in the treatment of complicated tibial plateau fractures.METHODS: Clinical data of 71 patients with complex tibial plateau fractures who underwent open reduction and internal fixation with double-incision locking plate and bone graft from January 2015 to January 2017 at the Affiliated Hospital of Traditional Chinese Medicine of Southwest Medical University were analyzed retrospectively. Among them, 35 cases(observation group) were treated with double-incision locking plate combined with Osteobone implantation bone graft, and 36 cases(control group) were treated with double-incision locking plate combined with autologous iliac bone graft. The informed consents were obtained from all patients and the trial was approved by the Ethics Committee of the hospital. The operation time, intraoperative blood loss, postoperative drainage volume and fracture healing time were compared between two groups. The Knee Injury and Osteoarthritis Outcome score, Hospital for Special Surgery score and Rasmussen imaging score were recorded in detail after operation. During the follow-up, the complications were statistically analyzed.RESULTS AND CONCLUSION:(1) The two groups of patients healed after treatment.(2) Follow-up results showed that the operation time,intraoperative blood loss, postoperative drainage volume, fracture healing time, pain and symptom points in Knee Injury and Osteoarthritis Outcome score, collapse score and total score in Rasmussen imaging, and incidence of complications in the observation group were significantly better than those in the control group(P < 0.05).(3) The varus score and condylar widening score in Rasmussen imaging, and ability of daily living, sports and entertainment points in Knee Injury and Osteoarthritis Outcome score showed no significant differences between two groups(P > 0.05).(4) These results imply that compared with the autologous iliac bone graft, the treatment of complex tibial plateau fractures with the double-incision locking plate internal fixation combined with Osteobone implantation can shorten the operation time,reduce bleeding and complications, form a stronger support, and accelerate fracture healing.
BACKGROUND: There are controversies about the treatment options for tibial plateau fractures.OBJECTIVE: To compare the clinical efficacy of double-incision locking plate combined with Osteobone implantation and autologous iliac bone graft in the treatment of complicated tibial plateau fractures.METHODS: Clinical data of 71 patients with complex tibial plateau fractures who underwent open reduction and internal fixation with double-incision locking plate and bone graft from January 2015 to January 2017 at the Affiliated Hospital of Traditional Chinese Medicine of Southwest Medical University were analyzed retrospectively. Among them, 35 cases(observation group) were treated with double-incision locking plate combined with Osteobone implantation bone graft, and 36 cases(control group) were treated with double-incision locking plate combined with autologous iliac bone graft. The informed consents were obtained from all patients and the trial was approved by the Ethics Committee of the hospital. The operation time, intraoperative blood loss, postoperative drainage volume and fracture healing time were compared between two groups. The Knee Injury and Osteoarthritis Outcome score, Hospital for Special Surgery score and Rasmussen imaging score were recorded in detail after operation. During the follow-up, the complications were statistically analyzed.RESULTS AND CONCLUSION:(1) The two groups of patients healed after treatment.(2) Follow-up results showed that the operation time,intraoperative blood loss, postoperative drainage volume, fracture healing time, pain and symptom points in Knee Injury and Osteoarthritis Outcome score, collapse score and total score in Rasmussen imaging, and incidence of complications in the observation group were significantly better than those in the control group(P < 0.05).(3) The varus score and condylar widening score in Rasmussen imaging, and ability of daily living, sports and entertainment points in Knee Injury and Osteoarthritis Outcome score showed no significant differences between two groups(P > 0.05).(4) These results imply that compared with the autologous iliac bone graft, the treatment of complex tibial plateau fractures with the double-incision locking plate internal fixation combined with Osteobone implantation can shorten the operation time,reduce bleeding and complications, form a stronger support, and accelerate fracture healing.
引文
[1]Ramponi DR.Tibial plateau fractures.Adv Emerg Nurs J.2018;40(3):155-161.
[2]Petersen W,Zantop T.Fracture of the tibial head.Der Unfallchirurg.2006;109(3):219-232;quiz 233-234.
[3]Yan B,Yin W,Zhang X,et al.Effectiveness analysis of surgical treatment of Schatzker type tibial plateau fractures].Zhongguo xiu fu chong jian wai ke za zhi.2017;31(11):1305-1310.
[4]Ollivier M,Bula?d Y,Jacquet C,et al.Fixation augmentation using calcium-phosphate bone substitute improves outcomes of complex tibial plateau fractures.A matched,cohort study.Int Orthop.2018;42(12):2915-2923.
[5]Belaid D,Vendeuvre T,Bouchoucha A,et al.Utility of cement injection to stabilize split-depression tibial plateau fracture by minimally invasive methods:A finite element analysis.Clin Biomech(Bristol,Avon).2018;56:27-35.
[6]Jia P,Lu FC,Ullah K,et al.Angle stable interlocking intramedullary nails for tibial plateau fractures.Orthop Surg.2018;10(2):115-120.
[7]Chang H,Zhu Y,Zheng Z,et al.Meta-analysis shows that highly comminuted bicondylar tibial plateau fractures treated by single lateral locking plate give similar outcomes as dual plate fixation.Int Orthop.2016;40(10):2129-2141.
[8]Neogi DS,Trikha V,Mishra KK,et al.Comparative study of single lateral locked plating versus double plating in type C bicondylar tibial plateau fractures.Indian J Orthop.2015;49(2):193-198.
[9]Sun H,Zhai QL,Xu YF,et al.Combined approaches for fixation of Schatzker type II tibial plateau fractures involving the posterolateral column:a prospective observational cohort study.Arch Orthop Trauma Surg.2015;135(2):209-221.
[10]Mandal A,Dutta P,Sarkar PS,et al.Single long midline incision versus two small incision techniques in treatment of Schatzker type V and type VI tibial plateau fractures--a comparative study.J Indian Med Assoc.2013;111(12):804-805.
[11]Kateros K,Galanakos SP,Kyriakopoulos G,et al.Complex tibial plateau fractures treated by hybrid external fixation system:a correlation of followup computed tomography derived quality of reduction with clinical results.Indian J Orthop.2018;52(2):161-169.
[12]Ryu SM,Yang HS.Staged treatment of bicondylar tibial plateau fracture(schatzker type v or vi)using temporary external fixator:correlation between clinical and radiological outcomes.Knee Surg Relat Res.2018;30(3):261-268.
[13]Bertrand ML,Pascual-López FJ.Severe tibial plateau fractures(Schatzker V-VI):open reduction and internal fixation versus hybrid external fixation.Injury.2017;8 Suppl 6:S81-S85.
[14]Tan HL,Dai PY,Liu WF.[Double-plate fixation via combined approaches for the treatment of old tibial plateau fractures of Schatzker type IV].Zhongguo gu shang.2017;30(10):891-895.
[15]Bertrand ML,Pascual-López FJ.Severe tibial plateau fractures(Schatzker V-VI):open reduction and internal fixation versus hybrid external fixation.Injury.2017;48 Suppl 6:S81-S85.
[16]Yuan GH,Zheng X,Chen K.Combined surgical approaches in the treatment of complex tibial plateau fractures.Zhongguo Gu Shang.2017;30(1):89-92.
[17]Zhang P,Li C,Chen F,et al.Treatment Of Posterolateral Tibial Plateau Collapsed And Splited Fractures By Posteromedial And Anterolateral Approaches.Zhongguo xiu fu chong jian wai ke za zhi.2015;29(9):1072-1075.
[18]Krause M,Hubert J,Deymann S,et al.Bone microarchitecture of the tibial plateau in skeletal health and osteoporosis.Knee.2018;25(4):559-567.
[19]Gausden E,Garner MR,Fabricant PD,et al.Do clinical outcomes correlate with bone density after open reduction and internal fixation of tibial plateau fractures.Arch Orthop Trauma Surg.2017;137(6):755-760.
[20]Bouler JM,Pilet P,Gauthier O.Biphasic calcium phosphate ceramics for bone reconstruction:A review of biological response.Acta Biomater.2017;53:1-12.
[21]Lu S,McGough MAP,Shiels SM,et al.Settable polymer/ceramic composite bone grafts stabilize weight-bearing tibial plateau slot defects and integrate with host bone in an ovine model.Biomaterials.2018;179:29-45.
[22]蒋熙,牛云飞,曹烈虎,等.自体髂骨解剖性重建在严重肱骨髁部创伤性骨缺损中的应用及远期随访[J].中华肩肘外科电子杂志,2016,4(4):202-206.
[23]石金柱,黄强,张玉富.解剖锁定钢板结合异体腓骨髓腔内结构植骨治疗复杂肱骨近端骨折[J].中华肩肘外科电子杂志,2017,5(4):272-277.
[24]Hanke A,B?umlein M,Lang S,et al.Long-term radiographic appearance of calcium-phosphate synthetic bone grafts after surgical treatment of tibial plateau fractures.Injury.2017;48(12):2807-2813.
[25]Li N,Li G,Guan T.Bilateral bone plate with autogenous iliac bone graft in treating Schatzker IV-VI complex tibial plateau fractures.Zhongguo Gu Shang.2015;28(12):1078-1082.
[26]Krettek C,Clausen J,Omar M,et al.Two-stage late reconstruction with a fresh large osteochondral shell allograft transplantation(FLOCSAT)for a large ostechondral defect in a non-union after a lateral tibia plateau fracture 2-year follow up.Injury.2017;48(7):1309-1318.
[27]Pomajzl RJ,Baker EA,Baker KC,et al.Case Series With Histopathologic and Radiographic Analyses Following Failure of Fresh Osteochondral Allografts of the Talus.Foot Ankle Int.2016;37(9):958-967.
[28]Rolvien T,Barvencik F,Klatte TO,et al.?-TCP bone substitutes in tibial plateau depression fractures.Knee.2017;24(5):1138-1145.
[29]Garrido CA,Sampaio TC.Use of bioceramics in filling bone defects.Rev Bras Ortop.2015;45(4):433-438.
[30]Barber FA,Dockery WD,Hrnack SA.Long-term degradation of a poly-lactide co-glycolide/β-tricalcium phosphate biocomposite interference screw.Arthroscopy.2011;27(5):637-643.
[31]罗睿,王银龙.灰度比评价奥邦骨修复材料对下颌骨缺损修复的有效性[J].中国美容医学,2018,27(3):114-117.
[32]Liu M,Nakasaki M,Shih YV,et al.Effect of age on biomaterialmediated in situ bone tissue regeneration.Acta Biomater.2018;78:329-340.
[33]黄波.双切口金属植入物内固定修复SchatzkerⅤ、Ⅵ型胫骨平台双髁骨折[J].中国组织工程研究,2015,19(15):2330-2335.
[34]文浩,段戡,袁长深,等.锁定钢板与双钢板内固定治疗SchatzkerⅣ-Ⅵ型胫骨平台骨折的Meta分析[J].中国矫形外科杂志,2014,2(20):1842-1846.
[35]Prat-Fabregat S,Camacho-Carrasco P.Treatment strategy for tibial plateau fractures:an update.EFORT Open Rev.2017;1(5):225-232.
[36]?zdemir G,Yilmaz B,?irin E,et al.The anatomical relationship of the neurovascular structures in direct posterior lateral gastrocnemius split approach for posterolateral tibial plateau fractures.Eur J Trauma Emerg Surg.2018;44(3):427-432.
[37]Cho JW,Kim J,Cho WT,et al.Approaches and fixation of the posterolateral fracture fragment in tibial plateau fractures:a review with an emphasis on rim plating via modified anterolateral approach.Int Orthop.2017;41(9):1887-1897.
[38]Menghi A,Mazzitelli G,Marzetti E,et al.Complex tibial plateau fractures:a retrospective study and proposal of treatment algorithm.Injury.2017;48 Suppl 3:S1-S6.
[39]Xu YQ,Li Q,Shen TG,et al.Case-control study on operative treatment for complex tibial plateau fracture.China J Orthop Traumatol.2013;26(1):65-70.
[40]Debnath UK,Jha DK.Results of ring(Ilizarov)fixator in high energy Schatzker type VI fractures of proximal tibia.J Clin Orthop Trauma.2018;9(2):186-191.
[41]Gross JB,Gavanier B,Belleville R,et al.Advantages of external hybrid fixators for treating Schatzker V-VI tibial plateau fractures:Aretrospective study of 40 cases.Orthop Traumatol Surg Res.2017;103(6):965-970.
[42]赵爱军,魏学庆,卢吉高,等.伴后外侧平台塌陷的SchatzkerⅤ/Ⅵ型胫骨平台骨折治疗[J].中国修复重建外科杂志,2013,27(5):639-640.
[43]Tohma Y,Takeuchi R.Advantages of creation of holes and removal of air in artificial bone for early bone formation when used artificial bone as a gap filler in open wedge high tibial osteotomy.Eur JOrthop Surg Traumatol.2019;29(1):131-137.
[44]Duymus TM,Mutlu S,Mutlu H,et al.Need for Bone Grafts in the Surgical Treatment of Displaced Intra-Articular Calcaneal Fractures.J Foot Ankle Surg.2017;56(1):54-58.
[45]Pan YX,Yang GG,Li ZW,et al.Clinical observation of biomimetic mineralized collagen artificial bone putty for bone reconstruction of calcaneus fracture.Regen Biomater.2018;5(2):61-67.
[46]Li J,Zhu Y,Liu B,et al.Incidence and risk factors for surgical site infection following open reduction and internal fixation of adult tibial plateau fractures.Int Orthop.2018;42(6):1397-1403.
[2]Petersen W,Zantop T.Fracture of the tibial head.Der Unfallchirurg.2006;109(3):219-232;quiz 233-234.
[3]Yan B,Yin W,Zhang X,et al.Effectiveness analysis of surgical treatment of Schatzker type tibial plateau fractures].Zhongguo xiu fu chong jian wai ke za zhi.2017;31(11):1305-1310.
[4]Ollivier M,Bula?d Y,Jacquet C,et al.Fixation augmentation using calcium-phosphate bone substitute improves outcomes of complex tibial plateau fractures.A matched,cohort study.Int Orthop.2018;42(12):2915-2923.
[5]Belaid D,Vendeuvre T,Bouchoucha A,et al.Utility of cement injection to stabilize split-depression tibial plateau fracture by minimally invasive methods:A finite element analysis.Clin Biomech(Bristol,Avon).2018;56:27-35.
[6]Jia P,Lu FC,Ullah K,et al.Angle stable interlocking intramedullary nails for tibial plateau fractures.Orthop Surg.2018;10(2):115-120.
[7]Chang H,Zhu Y,Zheng Z,et al.Meta-analysis shows that highly comminuted bicondylar tibial plateau fractures treated by single lateral locking plate give similar outcomes as dual plate fixation.Int Orthop.2016;40(10):2129-2141.
[8]Neogi DS,Trikha V,Mishra KK,et al.Comparative study of single lateral locked plating versus double plating in type C bicondylar tibial plateau fractures.Indian J Orthop.2015;49(2):193-198.
[9]Sun H,Zhai QL,Xu YF,et al.Combined approaches for fixation of Schatzker type II tibial plateau fractures involving the posterolateral column:a prospective observational cohort study.Arch Orthop Trauma Surg.2015;135(2):209-221.
[10]Mandal A,Dutta P,Sarkar PS,et al.Single long midline incision versus two small incision techniques in treatment of Schatzker type V and type VI tibial plateau fractures--a comparative study.J Indian Med Assoc.2013;111(12):804-805.
[11]Kateros K,Galanakos SP,Kyriakopoulos G,et al.Complex tibial plateau fractures treated by hybrid external fixation system:a correlation of followup computed tomography derived quality of reduction with clinical results.Indian J Orthop.2018;52(2):161-169.
[12]Ryu SM,Yang HS.Staged treatment of bicondylar tibial plateau fracture(schatzker type v or vi)using temporary external fixator:correlation between clinical and radiological outcomes.Knee Surg Relat Res.2018;30(3):261-268.
[13]Bertrand ML,Pascual-López FJ.Severe tibial plateau fractures(Schatzker V-VI):open reduction and internal fixation versus hybrid external fixation.Injury.2017;8 Suppl 6:S81-S85.
[14]Tan HL,Dai PY,Liu WF.[Double-plate fixation via combined approaches for the treatment of old tibial plateau fractures of Schatzker type IV].Zhongguo gu shang.2017;30(10):891-895.
[15]Bertrand ML,Pascual-López FJ.Severe tibial plateau fractures(Schatzker V-VI):open reduction and internal fixation versus hybrid external fixation.Injury.2017;48 Suppl 6:S81-S85.
[16]Yuan GH,Zheng X,Chen K.Combined surgical approaches in the treatment of complex tibial plateau fractures.Zhongguo Gu Shang.2017;30(1):89-92.
[17]Zhang P,Li C,Chen F,et al.Treatment Of Posterolateral Tibial Plateau Collapsed And Splited Fractures By Posteromedial And Anterolateral Approaches.Zhongguo xiu fu chong jian wai ke za zhi.2015;29(9):1072-1075.
[18]Krause M,Hubert J,Deymann S,et al.Bone microarchitecture of the tibial plateau in skeletal health and osteoporosis.Knee.2018;25(4):559-567.
[19]Gausden E,Garner MR,Fabricant PD,et al.Do clinical outcomes correlate with bone density after open reduction and internal fixation of tibial plateau fractures.Arch Orthop Trauma Surg.2017;137(6):755-760.
[20]Bouler JM,Pilet P,Gauthier O.Biphasic calcium phosphate ceramics for bone reconstruction:A review of biological response.Acta Biomater.2017;53:1-12.
[21]Lu S,McGough MAP,Shiels SM,et al.Settable polymer/ceramic composite bone grafts stabilize weight-bearing tibial plateau slot defects and integrate with host bone in an ovine model.Biomaterials.2018;179:29-45.
[22]蒋熙,牛云飞,曹烈虎,等.自体髂骨解剖性重建在严重肱骨髁部创伤性骨缺损中的应用及远期随访[J].中华肩肘外科电子杂志,2016,4(4):202-206.
[23]石金柱,黄强,张玉富.解剖锁定钢板结合异体腓骨髓腔内结构植骨治疗复杂肱骨近端骨折[J].中华肩肘外科电子杂志,2017,5(4):272-277.
[24]Hanke A,B?umlein M,Lang S,et al.Long-term radiographic appearance of calcium-phosphate synthetic bone grafts after surgical treatment of tibial plateau fractures.Injury.2017;48(12):2807-2813.
[25]Li N,Li G,Guan T.Bilateral bone plate with autogenous iliac bone graft in treating Schatzker IV-VI complex tibial plateau fractures.Zhongguo Gu Shang.2015;28(12):1078-1082.
[26]Krettek C,Clausen J,Omar M,et al.Two-stage late reconstruction with a fresh large osteochondral shell allograft transplantation(FLOCSAT)for a large ostechondral defect in a non-union after a lateral tibia plateau fracture 2-year follow up.Injury.2017;48(7):1309-1318.
[27]Pomajzl RJ,Baker EA,Baker KC,et al.Case Series With Histopathologic and Radiographic Analyses Following Failure of Fresh Osteochondral Allografts of the Talus.Foot Ankle Int.2016;37(9):958-967.
[28]Rolvien T,Barvencik F,Klatte TO,et al.?-TCP bone substitutes in tibial plateau depression fractures.Knee.2017;24(5):1138-1145.
[29]Garrido CA,Sampaio TC.Use of bioceramics in filling bone defects.Rev Bras Ortop.2015;45(4):433-438.
[30]Barber FA,Dockery WD,Hrnack SA.Long-term degradation of a poly-lactide co-glycolide/β-tricalcium phosphate biocomposite interference screw.Arthroscopy.2011;27(5):637-643.
[31]罗睿,王银龙.灰度比评价奥邦骨修复材料对下颌骨缺损修复的有效性[J].中国美容医学,2018,27(3):114-117.
[32]Liu M,Nakasaki M,Shih YV,et al.Effect of age on biomaterialmediated in situ bone tissue regeneration.Acta Biomater.2018;78:329-340.
[33]黄波.双切口金属植入物内固定修复SchatzkerⅤ、Ⅵ型胫骨平台双髁骨折[J].中国组织工程研究,2015,19(15):2330-2335.
[34]文浩,段戡,袁长深,等.锁定钢板与双钢板内固定治疗SchatzkerⅣ-Ⅵ型胫骨平台骨折的Meta分析[J].中国矫形外科杂志,2014,2(20):1842-1846.
[35]Prat-Fabregat S,Camacho-Carrasco P.Treatment strategy for tibial plateau fractures:an update.EFORT Open Rev.2017;1(5):225-232.
[36]?zdemir G,Yilmaz B,?irin E,et al.The anatomical relationship of the neurovascular structures in direct posterior lateral gastrocnemius split approach for posterolateral tibial plateau fractures.Eur J Trauma Emerg Surg.2018;44(3):427-432.
[37]Cho JW,Kim J,Cho WT,et al.Approaches and fixation of the posterolateral fracture fragment in tibial plateau fractures:a review with an emphasis on rim plating via modified anterolateral approach.Int Orthop.2017;41(9):1887-1897.
[38]Menghi A,Mazzitelli G,Marzetti E,et al.Complex tibial plateau fractures:a retrospective study and proposal of treatment algorithm.Injury.2017;48 Suppl 3:S1-S6.
[39]Xu YQ,Li Q,Shen TG,et al.Case-control study on operative treatment for complex tibial plateau fracture.China J Orthop Traumatol.2013;26(1):65-70.
[40]Debnath UK,Jha DK.Results of ring(Ilizarov)fixator in high energy Schatzker type VI fractures of proximal tibia.J Clin Orthop Trauma.2018;9(2):186-191.
[41]Gross JB,Gavanier B,Belleville R,et al.Advantages of external hybrid fixators for treating Schatzker V-VI tibial plateau fractures:Aretrospective study of 40 cases.Orthop Traumatol Surg Res.2017;103(6):965-970.
[42]赵爱军,魏学庆,卢吉高,等.伴后外侧平台塌陷的SchatzkerⅤ/Ⅵ型胫骨平台骨折治疗[J].中国修复重建外科杂志,2013,27(5):639-640.
[43]Tohma Y,Takeuchi R.Advantages of creation of holes and removal of air in artificial bone for early bone formation when used artificial bone as a gap filler in open wedge high tibial osteotomy.Eur JOrthop Surg Traumatol.2019;29(1):131-137.
[44]Duymus TM,Mutlu S,Mutlu H,et al.Need for Bone Grafts in the Surgical Treatment of Displaced Intra-Articular Calcaneal Fractures.J Foot Ankle Surg.2017;56(1):54-58.
[45]Pan YX,Yang GG,Li ZW,et al.Clinical observation of biomimetic mineralized collagen artificial bone putty for bone reconstruction of calcaneus fracture.Regen Biomater.2018;5(2):61-67.
[46]Li J,Zhu Y,Liu B,et al.Incidence and risk factors for surgical site infection following open reduction and internal fixation of adult tibial plateau fractures.Int Orthop.2018;42(6):1397-1403.